Cauda Equina Syndrome (CES)- Symptoms, Treatment and Prevention

Description

Cauda Equina syndrome (CES) is an impaired condition of lumbar plexus, nerve roots, and spinal canal below the termination of the spinal cord. It is a serious, acute neurologic condition. The term cauda equina is referring to the lower end of the spinal cord where the nerve fibres appear like a horse’s tail (in a Latin word ‘Cauda equina’). These nerves leave out from the spinal canal through the tunnel in between each vertebrae. Cauda equina is located behind the lumbar discs of the spinal canal. If this disc is prolapsed or slipped away, the nerves of cauda equina become squashed and trapped. The effects may appear at getting old age. The other names that are called for CES are Compression of Spinal Nerve Roots Syndrome and Spinal Nerve Roots Compression Syndrome.

Pathophysiology

The pathophysiology remains unclear, but it is believed that the damage to the roots of spinal nerves causes cauda equina by direct mechanical compression and ischemia or venous congestion.

Classification

Patient under CES can be classified as follows

Suspected

An individual who doesn’t have any symptoms, but he or she may develop CES.

Incomplete

An individual who with incomplete CES, shows signs as urinary difficulties due to spinal nerve damage, which also includes loss of eagerness to void, unaware straining to empty their bladder, and loss in their urinary sensation. These patients might develop CES.

Retention

An individual shows painless urinary retention and overflow incontinence. The bladder losses it controls due to insensitive involuntary muscles like the sphincter.

Complete

An individual, who completely lost their function of cauda equine, vanished perineal sensation and paralyzed bladder and bowel with a loose anus.

Epidemiology

Cauda equina syndrome is a rare syndrome occurs with prevalence estimated at approximately 1 in 65,000 (range about 33,000 to 100,000). It is, however, been estimated to occur in ~1% (range 0.1-2%) of lumbar disc herniation. No gender, racial, or ethnic preference was observed

Causes

There are various conditions that can cause cauda equine syndrome

  • Lumbar disc herniation (most commonly in L4/5 and L5/S1)
  • Lumbar spinal canal stenosis
  • Spondylolisthesis
  • Tarlov cysts
  • Facet joint cysts
  • Spinal fracture or dislocation
  • Epidural hematoma
  • Epidural abscess
  • Tuberculosis (Pott disease)
  • Lymphoma
  • Metastases
  • Primary CNS malignancies
  • Aortic dissection
  • Arteriovenous malformation

Risk factors

  • Individual with congenital or acquired spinal canal stenosis 3
  • Earlier lumbar spinal surgery
  • Penetrating trauma due to stabs and gunshots
  • Paget disease
  • Ankylosing spondylitis
  • Spina bifida
  • Hemorrhages affecting the spinal cord
  • Coagulopathy

It does not mean that the risk factors definitely lead to CES, quite it increases the chances of getting this condition when compared to a person without these risk factors.

Symptoms

Symptoms of CES include:

  • Low back pain
  • Numbness
  • Tingling in the buttocks and lower extremities
  • Sensory loss in both the legs or muscle weakness
  • Reduction of reflexes
  • Bowel incontinence causing retain urine and unable to hold it
  • Sexual dysfunction may suddenly occur

Complications

If the diagnosis and primary treatment are delayed, the following complications may arise such as follows:

  • Paralysis
  • Bladder, sexual and bowel dysfunction
  • Abnormalities in sensory systems

Diagnosis and test

If a person feels the above symptoms, he or she should seek medical advice immediately or visit the emergency department of your nearest hospital. Your doctor may perform some of the diagnosis such as follows:

  • Doctor may ask about your health history and other symptoms and activity
  • Physical examination to access your sensations, reflexes, stability, strength, movement and alignment
  • MRI scan, which uses magnetic fields and computers to produce three-dimensional images of your affected area in the spine
  • A myelogram – an X-ray of the spinal canal after injection of contrast material – which can pinpoint pressure on the spinal cord or nerves
  • CT scan

Treatment 

For the patients who with Cauda equina syndrome need surgery to prevent the permanent damage such as paralysis of the leg, loss of bowel and bladder control, sexual function or other problems. The main goal of the surgery is to restore the parts which are dysfunction. Based on the cause, the following surgery may be performed.

Discectomy

 Discectomy is the surgery in which the compressed nerves are removed from the portion of the disc. The window of bone is removed to expose the nerve root and disc by making an incision in the middle of the back by moving the spinal muscle aside. The portion of the ruptured disc compressing the spinal nerves is carefully removed.

Spinal decompression

Spinal decompression for stenosis removes the bone spurs and ligaments compressing the nerves. A small incision is made in the back. The surgeon removes the bone that forms the roof of the spinal canal. Next, soft tissue and bone spurs are removed to create more room for the nerves. Tumors and other lesions can also be removed.

Spinal cord disk compression

Medications

For long-term treatment, your doctor may prescribe drugs such as

  • Pain relievers after surgery such as oxycodone (OxyContin)
  • Over-the-counter pain relievers, such as ibuprofen (Advil) or acetaminophen (Tylenol), can be used for daily pain relief.
  • Corticosteroids are prescribed to reduce the inflammation and swelling around the spine
  • Hyoscyamine (Levsin), tolterodine (Detrol) and oxybutynin (Ditropan) for better bladder and bowel control

Prevention

  • Prevention of cauda equina syndrome is focused on early diagnosis by identifying the symptoms described.
  • While low back pain with leg pain and/or weakness is a common complaint that affects many people, cauda equina syndrome is a rare complication.
  • Your doctors should be vigilant in identifying these cases. You should familiarise yourself with the signs and symptoms that could suggest possible cauda equina syndrome, including a change in bowel or bladder function and loss of sensation in the groin.
  • Preventing infections and trauma is much essential to avoid these causes of cauda equina syndrome.

 

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61 comments

  1. Turibamwe Benjamin

    what treatment can be given to a person suffering from such a disease?

  2. what is the treatment of the disease

  3. any food to use they will be control

    • Using a laxative on a regular basis, eating a high fiber diet and maintaining a good fluid intake is useful measures to improve bowel control and assist bowels to empty.

  4. what is paining most is, I am not a science student. I love this App but don’t really understand some of the languages. I will asking you people any thing I didn’t get right thank you.

  5. can this also lead to erectile disfunction?

  6. can physical exercise fix the sliped disk?

  7. one of my disc has enter inside how can i treated it please

  8. what is the treatment of musclelar pain and preventive measures

    • taking an over-the-counter pain reliever, such as ibuprofen
      applying ice to the affected area to help relieve pain and reduce inflammation

  9. Rachel D Griffin-Morken

    Injuries on the Discs; Neck/lower back/CNS in the Spine/Head. Excruciating pains constantly, daily basis. Besides pain meds (not adequate to cope w/daily pains & mobility; as pains are incresing, Dr’s decreasing pain meds:completely debilitated due to pains-this is not a Living!) What options R there to relieve pains w/out surgery?

  10. I have swear lower back pain .just because of this reason so plz tell me what can I do …? which I can proper relief from swear pain

  11. Greetings. My feets are very hot most especially in the night and I have serious back pains. I have taken so many drugs but no response. What is the cause and the solution? Reply through my emails

  12. Your NamAli Mangu Ali

    long time ago I discover such problem at my back I had an accident at the toilet sit,when it break down with me,hit my back and some cut at my buttocks and cannot walk properly,bcos of financial problems I can not be able to treated myself properly,in which it is disturbing me by now.so can I go for x-ray and surgery or what can I do.pls i need advise.

  13. Añwar Bhai Vahora

    I was suffring from last 8 to years unable to

    walk, chugging , unbalanced , write, so please help & advise about treatment.

  14. my father has a similar problem now he hardly moves his legs his xlay shows a deformed backbone plz help

  15. suffering from this for the past month.
    diagnosed from MRI
    L5/S1
    not able to walk and severe pain.

    remedy
    15days complete bed rest. (ortho mattress and belt around the waist).
    only movement is to the washroom.
    diet is all healthy food without oil.
    three times a day Pregablin 75mg and pain killers for the first 7days. toradol and neubrol forte and Caflam.

    i am now doing fine. care and no weight lifting and driving for a month or so.

  16. My lower back is paining since 2002 when I was in advanced level secondary school. It is still paining since then although I have attended several times to different high profile hospitals.The common symptoms is lower back pain when hungry, thirsty & long call . I am now 40 years old. what should I do?

  17. please, is There any preventive drugs that will be taken before the surgery?

    thanks
    kind regards please.

  18. I have developed some back pains its going to a year now this filling is very severe ,not only this but also my tentacles inch too much when I am having this experience .ulushinga ,please help?

  19. This is what I’m suffering from, it started with urinary disorder, followed by serious lower-back pain for 6 months now and now I’m experiencing weakness in my legs. I have taken different analgesics as prescribed by doctors but the pain keeps coming back, it seems mine is hereditary as my father suffered from it before he died and it is affecting my siblings too right now. Please how can I manage this as I’m presently at military training for 9 months before I can be freed to see doctor?

  20. Rerialice Montgomery

    I have been in 3 accidents where I injured the tailbone and I suspect one side of a disc I can’t explain the pain sometimes burns or feels electric sometimes I have a pain. on the inside of the Leg down to my big toe and then that toe and the 2 toes next to it get so numb I can’t feel them the low part spine are sometimes hot sometimes I use. tigerbalm on it because of a halting healthcare I have had zilch treat m

  21. Alpha oumar Bayo

    Another way to be cure, without surgery.

    • There is no other way to cure or avoid future effects of Cauda Equina Syndrome. Surgery must be done quickly to prevent permanent damage, such as paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems. It is best if this occurs within 48 hours of the onset of symptoms.

  22. Rerialice Montgomery

    I am exrayed

  23. I am here going to give tips that helped me …I was prescribed capzine creme that is a derive from a pepper fruit it was effective but is sort of dangerous to handle if you get it in eyes or face so I made cream from white pepper I was easyer to handle and make soft or a bit hotter you remove it with oil not water this is nature remedy for some reason peppers work on nerve pain but don’t over use and don’t get it in eyes or face if you get it your. eyes wash it away with oil love to you al

  24. I want to more about spinal cord problem.

  25. can’t be cure?

    • If your cauda equina syndrome is chronic. You will need to learn ways to adapt to changes in your body’s functioning. You’ll find that both physical and emotional support is essential.

  26. Khalid Saifullah

    I’m suffering by this disease. it’s giving me a lot of pain backbone with left leg.
    I’m taking treatment many physiotherapist and other doctors but I can’t getting a good result.
    what I can do….???

  27. I was carrying a bag of rice this morning I was feeling waist pain seriously

  28. Desmond Ferdinand

    I have these symptoms In my back and it is causing paralysis and weakness in my legs, and makes me uneven balanced, I’m under day hospital only gives me pain relievers pills, cause I don’t want any surgery…

  29. Charles Mudenda

    I’m facing the same challenges, I was completely half paralyzed from waist to the legs, I’m now able to walk using a walking stick balancing is still a problem because the left leg is still weak, the remaining challenges are, painful legs, backbone, bladder, erectile dysfunction and holding of urine, what is your advice Dr

  30. what is medicine of back pain

  31. Your Methuselapojar

    can this disease cure?

    • it’s not curable. you may need fast treatment to prevent lasting damage leading to incontinence and possibly permanent paralysis of the leg

  32. As i have same pain ..as seen in pics ..its little bit gone through plaster and deep heat gel ..movex tablets ..also
    but still some times feeling shock type pain for seconds ..plz give me suggestions..advises ..thanks

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